Provider First Line Business Practice Location Address:
2570 GOODWATER AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96002-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-221-3376
Provider Business Practice Location Address Fax Number:
530-221-3378
Provider Enumeration Date:
03/10/2015